JP2015532454A - Surgical training model for laparoscopic procedures - Google Patents

Abstract

A model for practicing laparoscopic surgical skills is provided. The model has a plurality of practice stations at the top surface. The practice station has a cover that has a first closed position where the cavity is hidden under the cover and a second open position where the cover is moved to expose the cavity. The cover is coupled to the surface in a number of ways to provide a variety of tactile responses that are useful in fine-tuning laparoscopic surgical skills. The cover is configured as a hinged door with or without a bias, a flexible flap, a sliding cover, a lid, and a pierceable seat. The removable object is hidden in the cavity under the cover to practice handing the instrument in the laparoscopic environment, using both hands, replacing the instrument, determining the tissue plane and visualizing the tissue plane.

Description

  The present application relates generally to surgical training tools, and in particular teaches various surgical techniques and procedures related to (but not limited to) laparoscopic, endoscopic and minimally invasive surgery. It relates to simulated (simulated) tissue structures and models to be practiced.

[Description of related applications]
This application claims priority and interest in US Provisional Application No. 61 / 707,658 (Title: Surgical training model for laparoscopic procedures) filed on September 28, 2012. The provisional patent application is cited by reference, and the entire description is made a part of this specification.

  Medical students and skilled physicians who learn new surgical techniques (techniques) must undergo extensive training before they can qualify for surgery on humans as patients. This training must teach proper techniques using various medical instruments to cut, pierce, clamp, grasp, staple, cauterize and suture various types of tissue. The range of scenes that a trainee (trainee) may encounter is wide. For example, various organs and patient anatomy and disease are presented. The thickness and consistency of the various tissue layers can also vary between parts of the body and adjacent parts, and may vary from patient to patient. Different skills are required for different procedures. In addition, trainees are affected by various factors such as the patient's physique and pathology, the adjacent anatomical landscape of the target tissue and the landscape and whether the target tissue is easily accessible or relatively inaccessible. Techniques must be practiced in an anatomical environment.

  Many teaching aids, training instruments, simulated training devices (simulators) and model organs are available for one or more aspects of surgical training. However, there is a need for model organs or simulated tissue elements that may be encountered and that can be used in practicing laparoscopic procedures, minimally invasive surgical procedures (surgical procedures). In laparoscopic surgery, a trocar or cannula is inserted to access the body lumen and create a channel for insertion of a camera, such as a laparoscope. The camera provides live video feed capturing images, which are then displayed to the surgeon on one or more monitors. Another trocar / cannula is inserted to create a path through which the surgical instrument can be inserted. The surgeon performs a procedure to manipulate the instrument placed through the keyhole while observing the target anatomy on the video display. The target tissue location, such as the abdomen, is typically expanded by delivering carbon dioxide gas to vent or inject the body cavity to create a working space large enough to accept the scope and instrument used by the surgeon. The The gas injection pressure within the tissue cavity is maintained by using a dedicated trocar. Laparoscopic surgery offers many advantages when compared to open procedures. These benefits include less pain, less bleeding, and a shorter recovery period.

  In laparoscopic or endoscopic minimally invasive surgery, a high skill level is required compared to open surgery. This is because the target tissue is not directly observed by the physician. The target tissue is observed by a monitor that displays a portion of the surgical site that is accessed through a small opening. Therefore, the physician needs to visually determine the tissue plane and practice 3D depth perception, instrument handing, suturing, high precision cutting and tissue and instrument operation on a 2D viewing screen. Typically, a model that mimics a particular anatomical structure or procedure is placed in a simulated pelvis or lumbar training device, where the anatomical model is hidden from direct visualization (direct visualization) by the physician. Has been. The ports provided on the training instrument are used to practice techniques performed on the anatomical model hidden from direct visualization through the instrument. The simulated pelvic training instrument utilized basic skills and typical techniques used in laparoscopic surgery, such as grasping, manipulating, cutting, knotting, suturing, stapling, cauterization and these basic skills It is a functional, inexpensive and practical means to train surgeons and residents on how to perform specific surgical procedures. The simulated pelvic training device is also an effective sales tool for demonstrating the medical devices necessary to perform these laparoscopic procedures.

  Accordingly, it is desirable to provide a model that is suitable for practicing certain surgical techniques described above. In particular, there is a need for a model that only separates specific steps or techniques of the procedure, such as making a knot, grasping tissue, manipulating tissue, and moving tissue in a simulated laparoscopic environment. Has been. The laparoscopic training model is removably placed inside a simulated laparoscopic environment, eg, a laparoscopic training device, in which the laparoscopic training model is at least partially hidden from direct visualization. The camera and monitor provide the target model visualization to the physician. It is further desirable that after practice of the technique, such a model allows for easy, speedy and cost-effective repeatable training. In view of the foregoing, it is an object of the present invention to provide a surgical training instrument that can also be a platform for practicing surgical techniques that also allow repeatable practice. The use of simulated training equipment has greatly improved the skill level of new laparoscopic surgeons and has demonstrated that such simulated training equipment is an excellent tool for training future surgeons in a non-surgical setting environment. It was. There is a need for such improved and truly imminent and effective surgical training models.

  Surgical training instruments are provided for training and practicing laparoscopic procedures. The surgical training instrument has a laparoscopic training device. The laparoscopic training device includes a training device base and a training device top connected to the training device base and spaced from the training device base and forming a training device internal cavity with the training device base. And have. At least one hole or penetrable tissue simulation region for accessing the training device internal cavity is provided. A scope configured to capture the live video of the cavity is provided, and a video monitor is coupled to the scope and configured to display the live video of the cavity. A practice model is removably provided in the training device internal cavity, and the practice model is observable through a scope and video monitor, but is hidden from direct visualization at least by the top of the training device. The practice model has a base with an upper surface that, when provided within the laparoscopic training device, faces substantially upward toward the training device top cover. The base has two or more practice stations located on the top surface of the base. Each practice station has a cavity with an opening to the top surface. The cavity extends from the top surface into the base. A cover is connected to the base at the location of the cavity and can move relative to the base. The cover can move between a first position in the base that covers the opening to the cavity and a second position in the base that exposes the opening to the cavity. A removable target object is provided in the cavity. The target object is located under the cover and hidden from view when in the first position, and the sign object is removable from the cavity when the cover is in the second position.

  According to one aspect of the invention, a surgical training instrument is provided. The surgical training instrument has a base with a top surface and a bottom surface. A plurality of practice stations are formed at the base with the top facing the top. Each practice station has a cavity formed in the base, with an opening located at the top and extending into the base. A cover is connected to the base. The cover can move relative to the base between a first position that covers the opening to the base and a second position that exposes the opening to the cavity. A removable target object is provided inside the cavity. This target object is hidden under the cover when in the first position and is removable from the cavity when in the second position.

  According to another aspect of the invention, a method for practicing a laparoscopic procedure is provided. The method includes providing a laparoscopic training device. The laparoscopic training device includes a training device base and a training device top connected to the training device base and spaced from the training device base and forming a training device internal cavity with the training device base. And have. At least one hole or penetrable tissue simulation region for accessing the training device internal cavity is provided. A scope configured to capture the live video of the cavity is provided, and a video monitor is coupled to the scope and configured to display the live video of the cavity. A practice model is removably provided in the training device internal cavity, and the practice model is observable through a scope and video monitor, but is hidden from direct visualization at least by the top of the training device. The practice model has a base with an upper surface that, when provided within the laparoscopic training device, faces substantially upward toward the training device top cover. The base has two or more practice stations located on the top surface of the base. Each practice station has a cavity with an opening to the top surface. The cavity extends from the top surface into the base. A cover is connected to the base at the location of the cavity and can move relative to the base. The cover can move between a first position in the base that covers the opening to the cavity and a second position in the base that exposes the opening to the cavity. A removable target object is provided in the cavity. The target object is located under the cover and hidden from view when in the first position, and the sign object is removable from the cavity when the cover is in the second position. The method includes inserting at least one laparoscopic grasper into the training device cavity through at least one hole or penetrable tissue simulation region. The cover of one practice station is gripped by the gripper and the cover is moved from the first position to the second position. The removable target object is removed from the cavity while the cover is in the second position. A laparoscopic grasper is used to maintain the cover in the first position while another laparoscopic grasper is inserted through the at least one hole or penetrable tissue simulation region and into the training device cavity. Insert into the cavity of the practice station with the cover in the second position. A removable target object provided in the cavity of the practice station in the second position is grasped by the user using a laparoscopic grasper and removed from the cavity of the practice station. The method further includes providing another practice station with a plurality of spaced apart pegs coupled to the top surface of the base and extending upward from the top surface. Each peg is associated with a specific geometric shape. The removable target object has an opening configured to be passed over at least one peg, and the removable target object is associated with one of the geometric shapes of the at least one peg. Yes. This method identifies the geometric shape or color of a removable target object and uses a laparoscopic gripper to move the target object out of the cavity of the practice station and to move the target object to the corresponding geometric shape or color. Passing over the provided pegs. The method includes providing another practice station provided at the base and configured to practice knotting and unwinding using a laparoscopic grasper. The practice station has a first string with a proximal end attached to the top surface of the base and a second string with a proximal end attached to the top surface of the base adjacent to the first string. Each of the first and second strings has a free distal end. A removable target object is passed over one of the strings. The method includes unwinding the knot, removing the target object from the string, and placing the target object on one of the pegs. The method identifies a geometric shape or color associated with the target object and comprises the target object from a string and an associated geometric shape or color corresponding to the relevant geometric shape or color of the target object. Including moving on the peg. The method includes removing the target object while retaining a flexible or flexible cover. The method further includes the step of penetrating the cover with a surgical instrument to access the cavity of the base station, thereby removing the target object located within the cavity.

It is the perspective view seen from the surgical training apparatus of this invention from the top. It is a top view of the training model of the present invention.

  A surgical training instrument 10 made to mimic a patient's torso, eg, the abdominal region, is shown in FIG. Surgical training instrument 10 includes a body cavity 12 that is substantially hidden from the user and configured to receive the imitated or living tissue and model organs or training models described herein. The body cavity 12 is accessed via a tissue simulation region 14 that is perforated by performing a surgical procedure on a tissue or organ model that is provided for viewing by the user using instruments and instruments within the body cavity 12. The Although the body cavity 12 is shown as being accessible through the tissue mimicking region, alternatively, the body cavity 12 may be accessed using a hand access device or a single site port device. good. An exemplary surgical training instrument is described in US patent application Ser. No. 13 / 248,449 filed Sep. 29, 2011 (invention: Portable Laparoscopic Trainer), see this US patent application. The entire description is made a part of this specification. Surgical training instrument 10 is particularly suitable for practicing laparoscopic or other minimally invasive surgical procedures.

  Still referring to FIG. 1, the surgical training instrument 10 has a top cover 16 coupled to and spaced from the base 18 by at least one leg 20. Surgical training instrument 10 is made to mimic a patient's torso, for example the abdominal region. The top cover 16 represents the anterior surface of the patient, and the space between the top cover 16 and the base 18 represents the interior or body cavity of the patient where the organ is present. Surgical training device 10 is a useful tool for teaching, practicing, and demonstrating various surgical procedures and associated instruments in a simulation when a patient undergoes a surgical procedure. The surgical instrument is inserted into the cavity 12 from the side through the tissue simulation region 14 and through a hole 22 previously provided in the top cover 16 or between the top cover 16 and the base 18. Various tools and techniques can be used to pierce the top cover 16 so that a simulated procedure or training model placed between the top cover 16 and the base 18 can be performed. The base 18 has a model receiving area 24 or tray for staging or holding the training model. The model receiving area 24 of the base 18 has a frame-like element that holds the model in place so that the model does not slide around while the model (not shown) is being manipulated by a surgical instrument. doing. A clip attached to the retractable wire is provided at location 26 to help hold the training model on the base 18. The retractable wire is stretched and then clipped to hold the model in place substantially below the tissue simulation region 14. Another means of holding the model is a hook and loop (so-called Velcro®) fastening material patch (VELCRO®) attached to the base 18 within the model receiving area 24. This hook-and-loop fastening material patch is removably connectable to a complementary piece (VELCRO®) of hook-and-loop fastening material attached to the model.

  A video display monitor 28 hinged to the top cover 16 is shown in the closed orientation in FIG. The video monitor 62 can be connected to various visual systems that send images to the monitor. For example, a video monitor 28 and / or mobile can be inserted through one of the pre-provided holes 22 or the web cam (webcam) provided in the cavity 12 and used to observe the simulated procedure. The image may be provided to the user by connecting to a computing device. Audio recording or delivery means may also be provided and integrated with the training device 10, thereby providing audio and visual functions. Portable storage devices such as flash drives, smart phones, digital audio or video players or other digital mobile devices are also provided for recording training techniques and / or playing back pre-recorded video on a monitor for demonstration purposes. It is done. Of course, connection means are provided to provide audiovisual output to a large screen rather than a monitor. In another variant, the top cover 16 does not have a video display and supports a laptop computer, mobile digital device or tablet, such as IPAD®, which is connected to the training device by wire or wireless. Means to do.

  When assembled, the top cover 16 is positioned directly above the base 18 with the legs 20 disposed substantially along the periphery and interconnected between the top cover 16 and the base 18. The top cover 16 and the base 18 are of substantially the same shape and size and have substantially the same peripheral outline. Although the training device 10 does not have side walls, the legs 20 partially hide the internal cavity from view from another open training device 10. In the variant shown in FIG. 1, the legs 20 allow ambient light to illuminate the internal cavity as much as possible, and advantageously to provide as light a weight as is convenient for portability. Has an opening. The top cover 16 can be removed from the leg portion 20, and the leg portion 20 can be detached from the base portion 18 or can be folded with respect to the base portion 18 by a hinge or the like. Accordingly, the unassembled training device 10 has a reduced height that facilitates portability. In essence, the surgical training device 10 includes a simulated body cavity 12 that is hidden from the user. The body cavity 12 is configured to receive at least one surgical model that is accessible through at least one tissue simulation region 14 and / or a hole 22 provided in the top cover 16 or side, The model can be accessed through hole 22 to practice laparoscopic or endoscopic minimally invasive surgery.

  A model 30 for practicing the laparoscopic or open procedure and open technique of the present invention is shown in FIG. The model 30 is configured to be placed in the surgical training instrument 10 described above or other similar surgical training device. The model 30 has a base 32 and a plurality of practice stations 34 connected to the upper surface 36 of the base 32. Five practice stations 34a, 34b, 34c, 34d, and 34e are shown in FIG. 2, and each practice station is configured to practice individual surgical techniques or tasks employing traditional laparoscopic instruments. Yes.

  The base 32 is a platform that serves as the bottom support for the remainder of the model 30, and this base is sized and shaped so that the model 30 will not collapse. The platform is made of any material, such as metal or plastic. Base 32 is of sufficient weight to maintain the stability of model 30 in the upright position while being operated by the user. Model 30 is sized and shaped to be placed within body cavity 12 of surgical training device 10 at the location of model receiving area 24. The underside of the base 32 includes means for attaching the model 30 to the interior of the surgical training device 10. Such means for attaching the model 30 to the interior of the training device 10 include, but are not limited to, adhesives, suction cups, snap fits, magnets, and hook and loop fastening materials (surface fasteners). Rather, the hook and loop fastening material is attached to the bottom surface of the base 32 to bond with complementary hook and loop fastening material or adhesive attached to the base 18 of the surgical training device 10. It is configured.

  The first practice station 34 a has one or more pegs or posts 38 coupled to the base 32 and extending upward from the upper surface 36 of the base 32. The peg 38 is elongated and cylindrical in shape, but the present invention is not so limited, and the peg may be of any shape and size. The practice station 34 a has an object 40 with a hole 42 that is sized and configured to fit into one of the pegs 38. In order to place the object 40, it may be necessary to point the object so that the holes 42 of the object 40 are aligned with the shape of the pegs 38. In one variation, a peg 38 having various cross-sectional shapes is provided with an object having holes 42 corresponding to the shape of the peg 38. For an object 40 with a complex polygonal peg 38 and a corresponding polygon-shaped hole 42, for example, the user manipulates the object 40 to make this hole one of the correspondingly shaped pegs 38. Need to be able to pass over. During this practice, the user grasps the object 40 using a surgical instrument, such as a laparoscopic grasper, inserted into the hole 22, the simulated tissue penetration region 14 or the side of the training device 10, and Is lifted from one peg 38 and placed over and over another peg 38 so that the hole 42 in the object 40 is aligned with and fits into the peg 38. In one variation, for a plurality of pegs 38, each peg 38 has a different height. The various heights of the pegs 38 allow the user to practice depth perception while placing the object 40. In another training procedure, the peg 38 may have the same cross-sectional shape as shown in FIG. 2 and various shapes 76 are depicted on the top surface 36 of the base 32. Any of the other practice stations, such as the pegs having the drawn shape under the peg 38 corresponding to the shape of the removed objects 40, 60, 68 taken from the stations 34b, 34c, 34d. 38 may be arranged.

  The second practice station 34 b has a cover 44. The cover 44 is a rigid door 44 connected to the base 32 via a hinge 46, and the door 44 may further include a knob 48 connected to the outer surface of the door 44. The hinge 46 may be spring loaded so that the door 44 is biased to the closed position. Below the door 44 is a cavity (not shown) that can accommodate an object (not shown) that is hidden from view when the door 44 is closed. A cavity is formed in the base 32, and such a cavity may be of any shape or size and depth. The cavity opens toward the top surface 36 such that when the door 44 is moved, the cavity located under the door 44 is exposed. During this practice, the user grasps knob 48 or door 44 using a surgical instrument, such as a laparoscopic grasper, inserted into hole 22, simulated tissue penetration region 14 or the side of training device 10. Swing it open from the closed position. If the cavity is provided under the door 44, the user must keep the door 44 in the open position while holding another object with another instrument in the cavity with another hand. And take this out. In one variation, the string 50 is attached to the knob 48 or door 44 so that the user grips the string 50 rather than the knob 48 or door 44 and swings the door 44 to hold it open. can do. The object may be placed on the peg 38 at the first station 34a so that the object is placed on the peg 38 having a shape 76 that matches the shape associated with the object.

  The third practice station 34 c may have a cover 52 connected to the top surface of the base 32 by a connector 54, and the cover 52 may further have a knob 56 connected to the outer surface of the cover 52. The connector 54 is a fastener that causes the cover 44 to slide, swing or pivot about the fastener along the upper surface 36 of the base 32 so that the object 60 can optionally be a cavity. The cavity 58 under the cover 52 can be exposed in a state of being disposed inside the 58. The object 60 removed from the cavity 58 may then be placed on a peg 38 that matches the shape of the object 60. A cavity 58 is formed in the base 32, and this cavity may be of any shape or size and depth. Deep cavities can increase the level of difficulty with which the object 60 can be removed. The cavity 58 may be tortuous or may have a portion that is hidden from view by the wall so that the user recognizes whether the object 60 is hidden behind the wall in the cavity 58. You have to reach around obstacles with the instrument. The cavity 58 opens toward the top surface 36 so that when the cover 52 is moved from the first position covering the cavity 58 to the second position exposing the cavity 58, the opening to the cavity 58 as well as the cavity The object 60 arranged in 58 appears to the user. During this practice, the user grasps the knob 56 or cover 52 using a surgical instrument, such as a laparoscopic grasper, inserted into the hole 22, the simulated tissue penetration region 14, or the side of the training device 10. Then, it is rotated or slid to reach the second open position from the first closed position. When the cavity 58 is provided under the cover 52, the user reaches the interior of the cavity 58 and grips the object 60 with the same gripper or with another gripper held in the user's reverse hand. The object 60 may then be removed from the cavity 58 and placed on one side or removed from the training device 10. Alternatively, the object 60 may be disposed on the peg 38 at the first station 34a so that the object 60 is disposed on the peg 38 having a shape 76 that matches the shape associated with the object 60. Is done.

  The fourth practice station 34 d has a cover 62 connected to the base 32. The cover 62 is made of a soft material, such as a sheet of silicone or fabric. Cover 62 may be made of a material configured to simulate tissue, for example, silicone or other polymer sheets that may include a mesh or fabric reinforcement. The cover 62 is connected to the base 32 so that the flap 62 is formed. The flap is obtained because at least one edge or part of the cover 62 is sufficiently free to be lifted or separable from the top surface 36. The cover 62 of the station 34d is shown connected to the base 32 with two fasteners 64 and can later be gripped to expose a cavity 66 located under the flap 62 and At least one edge of the material that can be moved away from the top surface 36 or stretched is left. The fastener 64 is a screw or a pin, and an arbitrary number can be used to form the movable flap. In one variation, an adhesive is used to connect at least a portion of the flap 62 to the upper surface 36 of the base 32. At least a portion of the flap 62 is attached to the base 32 so that at least a portion of the flap 62 can be moved upward or lifted, thereby exposing the cavity 66 located under the flap 62. . The flap 62 can be elastic and can be stretched when it is lifted or made to mimic real tissue. A cavity 66 is formed in the base 32, and this cavity may be of any shape or size and depth. An object 68 is provided inside the cavity 66. During this practice, the user may use a surgical instrument, such as a laparoscopic grasper, inserted into the hole 22, the simulated tissue penetration region 14 or the side of the training device 10, and a flap that is not attached to the base 32. Pulling this free end of the flap 62 while grasping the free end of 62 and observing the model 30 on the video display 28 showing a live image of the procedure in the body cavity 12, and the object 68 in this cavity 66. To expose. When the cavity 66 is provided under the flap 62, the user holds the flap 62 in an open position with one hand holding the gripper while exposing the cavity 66, while the other hand holds the second gripper. Used to remove the object 68 from the cavity 66. FIG. 2 shows the user pulling the flap 62 with his / her finger and holding it open, thereby exposing the object 68 in the cavity 66 under the flap 62. Of course, the object 68 may be placed on the peg 38 at the first station 34 a so that the object 68 has a shape 76 that matches the shape associated with the object 68. Placed in. In one variation of the practice station 34d, the cover 62 does not include a flap or free edge that can be lifted from the top surface, instead the flexible or flexible cover 62 completely covers the cavity 66 and covers it. Seal. In such variations, the cover 62 is a pierceable material that can be cut open to create a flap to simulate a surgical wound made in the tissue to access the cavity 66, such as a sheet of silicone. Made with.

  The fifth practice station 34 e has a cover 70 in the form of a lid disposed above the cavity 72. The lid 70 may have a knob 74. The cover 70 is dimensioned to completely cover and conceal the underlying cavity 72, which cover may be of any shape, and the cover places the lid 70 in place above the cavity 72. It is preferable to have a protrusion provided on the lower surface of the lid 70 in order to help maintain. During this practice, the user grasps the lid 70 using a surgical instrument, such as a laparoscopic grasper, inserted into the hole 22, the simulated tissue penetration region 14, or the side of the training device 10. The user may hold the lid 70 or the knob 74 connected to the lid 70. The user lifts the lid 70 and brings it from a first position to a second position that exposes the cavity 72 located below and an object (not shown) disposed within the cavity 72. The object can be removed after the lid 72 is placed aside using the same grasper, or alternatively, the user can be inserted into the hole 22, the simulated tissue penetration region 14 or the side of the training device 10 and reversed. An object that can be found in the cavity 72 may be taken out and pulled out using another gripper held by the hand. Of course, the object may be placed on the peg 38 at the first station 34a so that the object is on the peg 38 with a shape 76 that matches the shape associated with the object 68. Be placed.

  In a sixth practice station not shown in FIG. 2, two strings are connected to the base 32. The string is attached to the upper surface 36 of the base 32 such that these connections to the upper surface 36 are spaced apart from each other. Each string has a free distal end and a length of about 1 to 3 inches (2.54 to 7.62 cm) in length as measured from its attachment point to its free distal end. The strings should be interchangeable, and these strings range in length from 3 inches (7.62 cm) to 10 inches (25.40 cm) and come in various thicknesses to vary the level of difficulty. Have During this practice, the user can use the surgical instrument inserted into the hole 22, the simulated tissue penetration region 14 or the side of the training device 10, such as a laparoscopic grasper, with one hand to free the first string. A second string using a second surgical instrument, such as a laparoscopic grasper, grasping the length and inserted into the hole 22, the simulated tissue penetration region 14 or the side of the training device 10 with the other hand Grip the free length. Holding both lengths of the string, the user manipulates the two strings in a knot-like manner, such as a suture knot. In this practice variant, an object 40 with holes is placed on the string and a knot is pre-made above the object 40. Next, the user performs an exercise of unwinding the knot and removing the object 40. The object 40 may have a shape that matches the shape located under one of the pegs 38. Next, the user moves the object 40 onto the peg 38 having the same shape as the object 40. Each string may have a different color that is easier to knot or untie than if both strings are the same color.

  In the practice station described above, cavities may or may not be formed under each movable object. In addition, each cavity may differ from the top surface 36 in terms of size and shape and depth so that the user can practice a sense of depth when removing an object. Each cavity can contain one or more objects, one of which is the target to be removed or the desired object. Inside the cavity, cutting practices that need to be performed to free the object from the cavity may be performed, for example, by the user replacing the instrument and replacing the surgical knife or other cutting instrument. It is necessary to use it. The objects are preferably color-coded so that the user must take out all objects of the same color. Also, in one variation, the target object is not placed in each cavity, which requires the user to find the target object by lifting a number of movable objects before finding the target object in the cavity. . The user can begin collecting two or more target objects. Also, any number of exercises may be performed within one base 32, and these exercises may be performed in a specific sequence that increases difficulty. For example, lifting the lid 70 of the fifth station 34e while taking out an object at the second station 34b as needed may be easier to perform than holding the flap door open. Moreover, various objects can be used, and these objects may be of arbitrary shapes. For example, the objects may be cylindrical, rounded, polymorphic, and these objects have surface structures, such as holes or protrusions, that can increase the user's dexterity with respect to operation. Is good.

  With the model 30 positioned within the cavity 12 of the laparoscopic training device 10, the distal end of the surgical instrument extends into the cavity 12 through the port 22, the hole 14 and / or the side of the training device 10. Execute the operation in the state. The distal end of the instrument is controlled by a user's hand located outside the training device 10. With the model 30 hidden from the user's direct observation, the user observes his manipulation on the model 30 on a video screen that provides a live feed through a scope inserted into the cavity 12. This set-up increases the physician's laparoscopic surgical skills by increasing the difficulty in performing repeatable steps encountered in actual surgery.

  The model 30 is advantageously and effective in that the user completes some of the practice at the practice station using both hands equally and simultaneously or concurrently. A stopwatch timer may be coupled to the model so that speed can be recorded competitively or evaluated for progress. Therefore, model 30 is useful for practicing various laparoscopic techniques, such as determining and visualizing tissue planes, practicing depth perception, hand-eye coordination, handing instruments, using both hands, Includes instrument replacement, knotting and tissue manipulation. This model allows clinicians to maintain their skills in an excellent state or “warm up” in advance to obtain successful results during actual surgery.

  While certain specific embodiments have been illustrated and described with reference to exemplary embodiments thereof, various changes in form and detail may be made without departing from the spirit and scope of the invention as set forth in the claims. Those skilled in the art will appreciate that can be performed.

Claims (19)

A surgical training instrument,
A laparoscopic training device, the laparoscopic training device,
A training device base;
A training device top coupled to the training device base and spaced from the training device base and defining a training device internal cavity with the training device base;
At least one hole or penetrable tissue simulation region for accessing the training device internal cavity;
A scope configured to capture live video of the cavity;
A video monitor coupled to the scope and configured to display the live video of the cavity;
Having a practice model removably provided in an internal cavity of the training device, the practice model being observable through the scope and the video monitor, but hidden from direct visualization at least by the top of the training device And the practice model is
Having a base with an upper surface facing upward substantially toward the training device top cover when provided within the laparoscopic training device, the base being disposed on the upper surface of the base It has two or more practice stations, and each practice station
Having a cavity with an opening to the top surface, the cavity extending from the top surface into the base;
A cover coupled to the base at the location of the cavity and movable relative to the base, the cover covering the opening with respect to the cavity within the base; Move between a second position in the base that exposes the opening to the cavity;
A removable target object provided in the cavity, the object being located under the cover and hidden from view when in the first position, the object being A surgical training instrument that is removable from the cavity when in the second position.   The base has another practice station with a plurality of spaced pegs connected to the top surface of the base and extending upward from the top surface, each peg having a specific Associated with a geometric shape, the removable target object having an opening configured to be passed over at least one peg, the removable target object having at least one peg The surgical training instrument of claim 1, wherein the surgical training instrument is associated with one of the geometric shapes.   The base has another practice station configured to practice knotting, the practice station having a first string with a proximal end attached to the top surface of the base and a proximal end of the first station. 2. The second string adjacent to the first string and attached to the top surface of the base, each of the first and second strings having a free distal end. Surgical training instrument.   The surgical training instrument of claim 3, wherein a target object with a hole is removably disposed on one of the first and second strings.   The surgical training instrument of claim 1, wherein the cover of an exercise station is hinged to the top surface of the base.   The surgical training instrument of claim 5, wherein the hinge is configured to bias the cover toward the top surface in a closed first position.   The cover of one practice station is connected to the base by a fastener at the upper surface, and the cover slides between the first position and the second position along the upper surface of the base. The surgical training instrument of claim 1, wherein the surgical training instrument is configured to move.   The cover of one practice station is at least partially on the top surface of the base to form a flap that can move relative to the base to cover or expose the opening to the cavity of the base. The surgical training instrument of claim 1, wherein the surgical training instrument is a joined flexible sheet of polymeric material.   The surgical training instrument of claim 8, wherein the cover is coupled to the base at two locations forming at least one free edge that is movable to expose the opening to the cavity of the base. .   The cover of one practice station is a sheet of silicone connected to the top surface of the base along the periphery of the opening to the cavity, the cavity being accessible by cutting the sheet The surgical training instrument according to claim 1.   The surgical training instrument of claim 1, wherein the cover of one practice station is a removable lid.   The surgical training instrument of claim 1, wherein the cover includes an upper surface and a handle or string coupled to and protruding from the upper surface to move the cover relative to the base. A surgical training instrument,
A base with a top surface and a bottom surface;
A plurality of practice stations formed on the base and facing the top surface, each practice station comprising:
A cavity formed in the base and having an opening located at the top surface and extending into the base;
A cover coupled to the base, the cover being located between the first position covering the opening relative to the base and the second position exposing the opening relative to the cavity. Can move,
A removable target object provided inside the cavity, the object being hidden under the cover when in the first position and removed from the cavity when in the second position; Surgical training instrument possible.   The surgical training instrument of claim 13, wherein the cover of one practice station is configured like a door and is connected at one end to a hinge.   The surgical training instrument of claim 14, wherein the hinge is configured to bias the cover toward the top surface in a closed first position.   The cover of one practice station is connected to the base by a fastener at the upper surface, and the cover slides between the first position and the second position along the upper surface of the base. The surgical training instrument of claim 13, wherein the surgical training instrument is configured to move.   The cover of one practice station is at least partially on the top surface of the base to form a flap that can move relative to the base to cover or expose the opening to the cavity of the base. The surgical training instrument of claim 13, wherein the surgical training instrument is a joined flexible sheet of polymeric material.   The surgical training instrument of claim 17, wherein the cover is coupled to the base at two locations forming at least one free edge that is movable to expose the opening to the cavity of the base. .   The base has another practice station with a plurality of spaced pegs connected to the top surface of the base and extending upward from the top surface, each peg having a specific Associated with a geometric shape, the removable target object having an opening configured to be passed over at least one peg, the removable target object having at least one peg The surgical training instrument of claim 13, wherein the surgical training instrument is associated with one of the geometric shapes.

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